Nerisa Iolani Soeharto, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3110 Guadalupe St Ste 100
Austin, TX 78705-2858

Phone

(512) 675-1359

NPI assigned

Sep 14, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Doctx3 PLLCGroup PAC ID 1355620055, 85 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Doctx3 PLLC

  • Orthopaedic Surgery Physician
  • Irving, TX
  • NPI 1467808618
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1770360588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 GUADALUPE ST STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787052858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 GUADALUPE ST STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787052858",
            "telephone_number": "512-675-1359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "709 E Slaughter Ln Ste 404",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787442156",
            "country_code": "US",
            "telephone_number": "512-277-6643",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 S I-35 Frontage Rd Suite N-5",
            "address_purpose": "LOCATION",
            "city": "Round Rock",
            "state": "TX",
            "postal_code": "78681",
            "country_code": "US",
            "telephone_number": "512-729-3138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOEHARTO",
        "first_name": "NERISA",
        "middle_name": "IOLANI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-14",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yulia Sobolevsky
• Lauren Renee Sobotik, PTA
• Ana Sobrino
• Soco Psychotherapy, Inc
• Soe Aung, M.D., P.a.
• Toshiki Soejima, DMD
• Sofia Luque, DDS, PLLC
• Sofia Wiltens LPT
• Soft Heart Counseling PLLC
• Soh of Texas Samson Liu PLLC

• Physician Assistant in Austin, TX
• Providers in Austin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.